Quantifying and reducing inequity in average treatment effect estimation

• Published in: BMC medical research methodology Vol. 23; no. 1; p. 297
• Main Authors: Nieser, Kenneth J, Cochran, Amy L
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 15.12.2023; BioMed Central; BMC
• Subjects: Average treatment effect; Bias; Computer Simulation; Demographic aspects; Estimates; Evaluation; Health care disparities; Hispanic Americans; Humans; Influence; Medical research; Medicine, Experimental; Methods; Minority & ethnic groups; Models, Statistical; Random variables; Researchers; Sample representativeness; Subgroup analysis; Treatment outcome; United States; Subgroup analysis; Average treatment effect; Sample representativeness
• ISSN: 1471-2288; 1471-2288
• DOI: 10.1186/s12874-023-02104-2

Across studies of average treatment effects, some population subgroups consistently have lower representation than others which can lead to discrepancies in how well results generalize. We develop a framework for quantifying inequity due to systemic disparities in sample representation and a method for mitigation during data analysis. Assuming subgroup treatment effects are exchangeable, an unbiased sample average treatment effect estimator will have lower mean-squared error, on average across studies, for subgroups with less representation when treatment effects vary. We present a method for estimating average treatment effects in representation-adjusted samples which enables subgroups to optimally leverage information from the full sample rather than only their own subgroup's data. Two approaches for specifying representation adjustment are offered-one minimizes average mean-squared error for each subgroup separately and the other balances minimization of mean-squared error and equal representation. We conduct simulation studies to compare the performance of the proposed estimators to several subgroup-specific estimators. We find that the proposed estimators generally provide lower mean squared error, particularly for smaller subgroups, relative to the other estimators. As a case study, we apply this method to a subgroup analysis from a published study. We recommend the use of the proposed estimators to mitigate the impact of disparities in representation, though structural change is ultimately needed.